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van Dijk N, de Jongh W, Stärcke P, Shaw D, Bollen J, van Mook W. Case report: Organ donation after euthanasia for psychiatric suffering: some of the practical and ethical lessons Martijn taught us. Front Psychiatry 2024; 15:1234741. [PMID: 38505793 PMCID: PMC10948434 DOI: 10.3389/fpsyt.2024.1234741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024] Open
Abstract
Euthanasia in psychiatric patients presents unique challenges, especially when combined with organ donation. In this article, the hurdles psychiatric patients might encounter after expressing their wish for organ donation after euthanasia, are discussed and illustrated by the case of Martijn, a 45-year-old psychiatric patient who altruistically donated his organs after euthanasia. Hospital and physician-related factors, including caution in determination of mental capacity, consideration of conflicting interests, and healthcare staff stress are discussed as impediments to organ donation after euthanasia (ODE) in psychiatric patients. The primary objective of this article is to raise awareness among psychiatrists regarding the fact that although the combination of euthanasia and organ donation is an uncommonly performed procedure, it is frequently requested by psychiatric patients. In conclusion, the article advocates for a nuanced approach, respecting patients' altruistic wishes while at the same time addressing challenges associated with ODE in psychiatric suffering. Where possible, and within the current medical, ethical and legal boundaries, the importance of facilitating organ donation without unnecessarily prolonging the suffering of competent psychiatric patients seeking euthanasia is emphasized. The topic calls, for example, for further qualitative research to understand the stakeholders' perspectives to determine the perceived possibilities on the one hand and boundaries on the other.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Wim de Jongh
- Department of Organ Donation Coordination, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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2
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Grunwald J. Personalism and boosting organ ResERVOirs: a consideration of euthanasia by removal of vital organs in the Canadian context. MEDICAL HUMANITIES 2024; 50:191-195. [PMID: 38195243 DOI: 10.1136/medhum-2023-012772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/11/2024]
Abstract
Canada's decriminalisation of assisted death has elicited significant ethical implications for the use of assisted death in healthcare contexts. Euthanasia by removal of vital organs (ERVO) is a theoretical extension of medically assisted death with an increased plausibility of implementation in light of the rapid expansion of assisted death eligibility laws and criteria in Canada. ERVO entails removing organs from a living patient under general anaesthesia as the mechanism of death. While ERVO is intended to maximise the viability of organs procured from the euthanised patient for donation to recipients, ending the lives of patient donors in this manner solely to benefit ill or dying recipient patients merits further ethical consideration. Specifically, the paper explores the application of personalist bioethics in determining whether the means of procuring organs through assisted death justifies the end of improving the lives of those who would benefit from receiving them. Further, by discussing the medical, social and ethical implications of ERVO, I will explicate a broader philosophical understanding of the influences of legalising assisted death on human dignity and conscience.
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Affiliation(s)
- Jamie Grunwald
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- University of Saskatchewan Department of Family Medicine, Prince Albert, Saskatchewan, Canada
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3
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Mulder J, Sonneveld H. Feasibility of organ donation following voluntary assisted dying in Australia: lessons from international practice. Med J Aust 2024; 220:164. [PMID: 38238880 DOI: 10.5694/mja2.52205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/13/2023] [Indexed: 02/19/2024]
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Royo-Villanova M, Miñambres E, Sánchez JM, Torres E, Manso C, Ballesteros MÁ, Parrilla G, de Paco Tudela G, Coll E, Pérez-Blanco A, Domínguez-Gil B. Maintaining the permanence principle of death during normothermic regional perfusion in controlled donation after the circulatory determination of death: Results of a prospective clinical study. Am J Transplant 2024; 24:213-221. [PMID: 37739346 DOI: 10.1016/j.ajt.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Abstract
One concern about the use of normothermic regional perfusion (NRP) in controlled donation after the circulatory determination of death (cDCD) is that the brain may be perfused. We aimed to demonstrate that certain technical maneuvers preclude such brain perfusion. A nonrandomized trial was performed on cDCD donors. In abdominal normothermic regional perfusion (A-NRP), the thoracic aorta was blocked with an intra-aortic occlusion balloon. In thoracoabdominal normothermic regional perfusion (TA-NRP), the arch vessels were clamped and the cephalad ends vented to the atmosphere. The mean intracranial arterial blood pressure (ICBP) was invasively measured at the circle of Willis. Ten cDCD donors subject to A-NRP or TA-NRP were included. Mean ICBP and mean blood pressure at the thoracic and the abdominal aorta during the circulatory arrest were 17 (standard deviation [SD], 3), 17 (SD, 3), and 18 (SD, 4) mmHg, respectively. When A-NRP started, pressure at the abdominal aorta increased to 50 (SD, 13) mmHg, while the ICBP remained unchanged. When TA-NRP was initiated, thoracic aorta pressure increased to 71 (SD, 18) mmHg, but the ICBP remained unmodified. Recorded values of ICBP during NRP were 10 mmHg. In conclusion, appropriate technical measures applied during NRP preclude perfusion of the brain in cDCD. This study might help to expand NRP and increase the number of organs available for transplantation.
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Affiliation(s)
- Mario Royo-Villanova
- Donor Transplant Coordination Unit, Service of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Eduardo Miñambres
- Donor Transplant Coordination Unit, Service of Intensive Care, Hospital Universitario Marqués de Valdecilla-IDIVAL, School of Medicine, Universidad de Cantabria, Santander, Spain.
| | - José Moya Sánchez
- Donor Transplant Coordination Unit, Service of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Eduardo Torres
- Neuro-intervention Unit, Hospital Universitario de Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Clara Manso
- Service of Intensive Care, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - María Ángeles Ballesteros
- Donor Transplant Coordination Unit, Service of Intensive Care, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Guillermo Parrilla
- Interventional Neurovascular Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Gonzalo de Paco Tudela
- Interventional Neurovascular Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Bollen J, Hempton C, Bhatia N, Tibballs J. Feasibility of organ donation following voluntary assisted dying in Australia: lessons from international practice. Med J Aust 2023; 219:202-205. [PMID: 37393567 DOI: 10.5694/mja2.52016] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Jan Bollen
- Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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Kaffka genaamd Dengler SE, Vervoorn MT, Brouwer M, de Jonge J, van der Kaaij NP. Dilemmas concerning heart procurement in controlled donation after circulatory death. Front Cardiovasc Med 2023; 10:1225543. [PMID: 37583588 PMCID: PMC10424927 DOI: 10.3389/fcvm.2023.1225543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
With an expanding population at risk for heart failure and the resulting increase in patients admitted to the waiting list for heart transplantation, the demand of viable organs exceeds the supply of suitable donor hearts. Use of hearts after circulatory death has reduced this deficit. Two primary techniques for heart procurement in circulatory death donors have been described: direct procurement and perfusion and thoraco-abdominal normothermic regional perfusion. While the former has been accepted as an option for heart procurement in circulatory death donors, the latter technique has raised some ethical questions in relation to the dead donor rule. In this paper we discuss the current dilemmas regarding these heart procurement protocols in circulatory death donors.
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Affiliation(s)
| | - M. T. Vervoorn
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - M. Brouwer
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - J. de Jonge
- Department of Surgery, Erasmus Medical Center Transplant Institute, Rotterdam, Netherlands
| | - N. P. van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands
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Mulder J, Sonneveld H. Organ donation after euthanasia starting with anesthesia at home is legal in The Netherlands, Belgium, Canada and Spain. BMC Med Ethics 2023; 24:34. [PMID: 37248520 DOI: 10.1186/s12910-023-00906-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/03/2023] [Indexed: 05/31/2023] Open
Abstract
We would like to respond to the article "Organ donation after euthanasia starting at home in a patient with multiple system atrophy Tajaâte et al., [2021] 22:120" on organ donation after euthanasia from home [ODEH]. Although we welcome the performance of ODEH, we would like to make some critical comments regarding the article, both in relation to factual inaccuracies and in terms of the vision expressed on this subject. In this letter we stress the protection of autonomy of vulnerable euthanasia patients, we contradict the assumption of illegality, we question if the anesthesia method utilized is optimal and correct a mistake in regard to an article to which is referred of ourselves.
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Affiliation(s)
- Johannes Mulder
- Anaesthesiology-Intensive Care Department, Isala Hospitals, Zwolle, The Netherlands.
| | - Hans Sonneveld
- Anaesthesiology-Intensive Care Department, Isala Hospitals, Zwolle, The Netherlands
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Ray R, Martin D. Missed opportunities: saving lives through organ donation following voluntary assisted dying. Intern Med J 2023; 53:861-865. [PMID: 37139939 DOI: 10.1111/imj.16085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/24/2023] [Indexed: 05/05/2023]
Abstract
Organ donation after voluntary assisted dying (VAD) in Australia may potentially increase organ transplant rates. Despite significant international experience with donation after VAD, there has been little discussion of this in Australia. We review potential ethical and practical concerns relating to donation after VAD and advocate action to establish programmes in Australia that ensure safe, ethical and effective donation after VAD.
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Affiliation(s)
- Robert Ray
- School of Medicine, Deakin University, Victoria, Geelong, Australia
- Barwon Health, University Hospital Geelong, Victoria, Geelong, Australia
| | - Dominique Martin
- School of Medicine, Deakin University, Victoria, Geelong, Australia
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Ramsay MA, Wall AE. Medical Assistance in Dying and Organ Donation, the Ultimate Gift: Have We Got the Ethics Right? Ann Surg 2023; 277:719-720. [PMID: 36727848 DOI: 10.1097/sla.0000000000005806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Michael A Ramsay
- Department of Anesthesiology, Baylor University Medical Center, Dallas, TX
| | - Anji E Wall
- Department of Surgery, Annette C and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
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Lennon C, Harvey D, Goldstein PA. Ethical considerations for theatre teams in organ donation after circulatory determination of death. Br J Anaesth 2023; 130:502-507. [PMID: 36801100 DOI: 10.1016/j.bja.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/20/2022] [Accepted: 01/15/2023] [Indexed: 02/18/2023] Open
Abstract
Transplant surgery is an area that gives rise to a number of ethical considerations. As medicine continues to expand the boundaries of what is technically possible, we must consider the ethical implications of our interventions, not solely on patients and society, but also on those asked to provide that care. Here, we consider physician participation in procedures required to provide patient care in the context of the ethical convictions held by the physician, with an emphasis on organ donation after circulatory determination of death. Strategies that can be used to mitigate any potential negative impact on the psychological well-being of members of the patient care team are considered.
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Affiliation(s)
| | - Dan Harvey
- National Health Service Blood & Transplant, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter A Goldstein
- Department of Anesthesiology, New York, NY, USA; Department of Medicine, New York, NY, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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van Dijk N, Stärcke P, de Jongh W, Jansen N, Shaw D, Bollen J, van Mook W. Organ Donation After Euthanasia in Patients Suffering From Psychiatric Disorders: 10-Years of Preliminary Experiences in the Netherlands. Transpl Int 2023; 36:10934. [PMID: 36846601 PMCID: PMC9948004 DOI: 10.3389/ti.2023.10934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
Euthanasia based on psychiatric suffering, followed by subsequent organ donation, is considered medically and legally permissible in the Netherlands. Although organ donation after euthanasia (ODE) in patients suffering from unbearable psychiatric illness is performed, it is not specifically addressed in the Dutch guideline on organ donation after euthanasia, and national data on ODE in psychiatric patients have not yet been published. In this article, the preliminary results of the 10-year Dutch case series of psychiatric patients who choose ODE are presented and potential factors influencing opportunities for donation in this population are discussed. We conclude that further future in-depth qualitative exploration of ODE in patients suffering from psychiatric illness and its associated ethical and practical dilemmas, including the consequences for the patient and their family and healthcare professionals, will be important to help make sense of potential barriers to donation for people undergoing euthanasia as a result of psychiatric suffering.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - Wim de Jongh
- Department of Surgery, Transplantation Coordination Services, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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